Inflammation of the abdominal muscle at the point of attachment on the pubic bone

Anatomy: The pelvis consists of two halves, joined at the back by the sacral bone (os sacrum) and at the front by the pubic joint (symphysis). The abdominal muscle (M rectus abdominis) is fastened on the pubic bone and helps bend the back (so that the head is brought towards the knee). The adductor muscles in the thigh (amongst others the M adductor longus) are fastened in the groin just below the pubic bone.

Symptoms: Pain around the abdominal muscle fastening on the pubic bone, worsening when applying pressure, stretching and activation of the abdominal muscles (sit-ups, stomach crunches).

Acute treatment: Click here.

Examination: In light cases, medical examination is not necessarily required. Severe cases or cases not improved by treatment, should be evaluated by a doctor to make a precise diagnosis. A normal medical examination is usually sufficient in order to make the diagnosis. If upon examination there is pain when applying pressure on the muscle fastening in the groin, worsening at the same location upon stretching and activation (sit-ups), there is hardly any doubt concerning the diagnosis even though the diagnosis of groin pain can be particularly difficult (article). However, if there is any doubt concerning the diagnosis an ultrasound scan can be performed. Ultrasound examination is well suited to evaluate the muscles in the area.

Treatment: The treatment usually consists of relief and cautious rehabilitation. In case of lack of progress with rehabilitation, medical treatment can be considered in the form of rheumatic medicine (NSAID) or the injection of corticosteroid along the inflamed part of the muscle fastening on the pubic bone. Surgery is rarely necessary (and the results are not convincing).

Complications: If satisfactory progress is not achieved, it should be considered whether the diagnosis is correct or whether complications have arisen. In particular the following should be considered:

• Inflammation of the adductor muscle of the thigh
• Rupture of the adductor muscle of the thigh
• Inflammation of the pubic joint (osteitis pubis)
• Bursitis on the front of the hip joint (bursitis iliopectinea)
• Other bursitis
• Fluid accumulation in the hip joint
• Degenerative arthritis in the hip joint
• Rupture of the superficial hip flexor (ruptura musculus rectus femoris)
• Rupture of the deep hip flexor (ruptura musculus iliopsoas)
• Outer snapping hip
• Inner snapping hip
• Stress fracture in the femoral neck
• Inguinal hernia
• “Sportsman’s hernia”
• Nerve entrapment

Special: Shock absorbing shoes or inlays will reduce the load on the muscle fastenings. In case of lack of progress or relapse after successful rehabilitation, a running style analysis can be considered to evaluate whether correction of the running style should be recommended.